Decision making in health care: limitations of the substituted judgement principle

The substituted judgement principle is often recommended as a means of promoting the self-determination of an incompetent individual when proxy decision makers are faced with having to make decisions about health care. This article represents a critical ethical analysis of this decision-making principle and describes practical impediments that serve to undermine its fundamental purpose. These impediments predominantly stem from the informality associated with the application of the substituted judgement principle. It is recommended that the principles upon which decisions are made about health care for another person should be transparent to all those involved in the process. Furthermore, the substituted judgement principle requires greater rigour in its practical application than currently tends to be the case. It may be that this principle should be subsumed as a component of advance directives in order that it fulfils its aim of serving to respect the self-determination of incompetent individuals.

Sexual decision making in young women

Research over the last 30 years has examined the way in which young people make decisions about participating in sexual behaviours. This research is limited in that theoretical developments in the area have either not been subjected to empirical scrutiny, or are not consistent with empirical findings. The current study used a modified form of the Theory of Planned Behavior (TPB) as a theoretical position for a longitudinal exploration (over a 6-month period) of sexual decision making in a group of young adult women. One hundred and fifty-six young women aged between 18 and 21 years were involved in the study. Regression analysis were used to evaluate the predictors of intention to engage in six types of sexual behaviours at time 1, as well as experiences of these behaviours at time 2. The study found that intention to engage in sexual behaviour was reasonably well predicted using the constructs of TPB. However, behaviour was not well predicted using the variables in TPB, with the most important predictors of most sexual behaviours being past experience and perceived behavioural control, but not intention to engage in the behaviours. Implications of these findings and directions for future research are discussed.

A new interlink decision making index for making multi-criteria decisions

In this paper a mechanism that is the brain child of the authors, has been proposed to overcome the potential manipulation of results as a direct consequence of the applied weightings. It is known as the Interlink Decision Making Index

Piercing the decision-making sphere : happiness as the key to real shareholder participation

The purpose of this article is to explain why recent corporate governance reforms and initiatives proclaiming to enhance shareholder participation and elevate shareholder rights, do not go far enough. Indeed, it is suggested that corporate governance polices and reform programs, which have emerged across the world in response to a number of high-profile corporate collapses, act to re-emphasise the limited, 'passive' role which individual shareholders have traditionally experienced in public companies. Although increasing the amount information provided to shareholders about corporate decisions and strategies, and providing shareholders with a greater opportunity to participate in annual general meetings, do go some way in 'empowering' shareholders, it is argued that shareholders essentially remain passive observers, rather than becoming active participants. To become active participants, or corporate governance 'insiders " it is argued that corporate law needs to be directed at piercing the 'decision-making sphere' for individual shareholders in public companies. This involves accommodating an active role for shareholders in the actual decision-making processes of the corporation, rather than simply being informed of decisions that are made and being entitled to veto decisions at the annual general meeting. The second part of the article looks specifically at how the 'oppression' or 'unfair prejudice' remedy, the most commonly used shareholder remedy, is capable - if reformulated so that the pursuit of happiness, rather than vague notions of 'fairness' and 'justice' is the central objective of the remedy - of being used to influence a change of culture within public companies directed at facilitating an active participatory role for shareholders.

The effects of specific educational preparation on emergency nurses` clinical decisions regarding supplemental oxygen administration

Abstract The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes.

A critical examination of ethical decision making models

This paper critically examines both the need for, and the use of, ethical decision making models (EDMMs). This paper suggests that EDMMs focus on arriving at the correct decision but ignore the action required to implement it and are therefore incomplete. In most “accounting” circumstances, finding the right decision is not what is required. Rather, a model which provides both a sound decision and, appropriate implementation would be more useful. In trying to establish a new/different EDDM that provides for this it is argued that a biblical model exists which addresses both decision making and action. This paper aims to encourage accounting ethics education to move beyond determining the right decision and focus on taking the right action.

The role of information and communication technology in the urgent decision making process : a work in progress report

This paper reports part of a study that examines how members of a senior management team in a public sector organisation make decisions under urgency. Four regional managers, who are geographically dispersed around New Zealand were interviewed, either face-to-face or via telephone, regarding their experiences of decision making under urgency.

Preliminary results indicate that only three out of a possible seven steps of a conventional decision making process are used during the urgent decision making process. The study also shows that participants do not fully utilise the information and communication technology available during the decision making process. The implications the findings have for practice and research are discussed.

Parental decision-making surrounding complicated births: the impact on parent-infant and infant-marital relationships

This paper reviews current research regarding the impact of birth complications on parental decisionmaking, and the resulting effects on parent-infant and infant-marital relationships. It discusses the importance of informed decision-making on parental satisfaction of the birthing experience, and the benefits of certain strategies, such as kangaroo care, in the facilitation of greater levels of attachment and improved relationships. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Strategic decision-making and emotions

Senior management decisions play a critical role not only in organizational performance but also in the competitiveness of Australia in the international arena. In this conceptual paper, I present a multi-level model of affect in strategic decision-making to understand the impact that emotions have on senior managements' decision-making processes. The aim of the model is to extent on current theory (specifically Affective Events Theory) to minimize the negative impact of emotions on decision-making to produce high quality decisions and, consequently, more effective and competitive organizations. Hypotheses, practical implications and future research opportunities are also discussed.